Pediatric pneumology | Specialists and information

What is pediatric pneumology?

Pneumology covers the entire respiratory system. In addition to the lungs, the respiratory tract also includes the paranasal sinuses, the larynx and the trachea.

In pulmonology, the focus is primarily on the bronchi, the mediastinum (middle pleural cavity) and the pleura (pleura, lung pleura, pleura).

Of course, diseases of the lungs themselves are also part of pulmonology. The causes and symptoms of lung diseases in newborns, children and adolescents differ significantly from those in adults.

Due to the special characteristics of children, pediatric pulmonology deals with diseases of the airways and breathing in children.

What is a pediatric pulmonologist?

Pediatric pneumology is a specialty of pediatrics. A pediatric pneumologist is a doctor who has completed five years of further training to become a specialist in pediatric and adolescent medicine. He has then completed three years of additional training in the field of pediatric pneumology.

Further training as a pediatric pneumologist involves acquiring knowledge about the diagnosis and treatment of respiratory diseases. In particular, diseases of the lungs, bronchi, pleura and mediastinum in children and adolescents.

Pediatric pneumologists treat these diseases

The most common lung disease in children is bronchial asthma. It is a chronic disease of the respiratory tract that manifests itself in attacks of breathlessness with difficult exhalation.

A pediatric pulmonologist also treats recurring inflammation of the bronchial tubes and pneumonia as well as chronic lung diseases, which often occur after premature birth.

A pediatric pulmonologist is also the right specialist for the following diseases:

• Cystic fibrosis (mucoviscidosis )
• Congenital lung and airway malformations, which can often cause recurring lung infections, such asUnventilated sections of the lungs (pulmonary sequestration), over-inflation of the lungs(pulmonary emphysema), cysts in the lungs and bronchi, tracheal diverticula (dilatations in the trachea),narrowing of the bronchi
• Sleep-related breathing regulation disorders such as sleep apnea syndrome
• Tuberculosis
• Interstitial lung diseases (diffuse lung parenchymal disease), such as sarcoidosis or exogenous allergic alveolitis (allergic overreaction of the lungs)
• Lung diseases in premature infants and newborns, such as bronchopulmonary dysplasia (impairment of lung function)
• respiratory distress syndrome
• Obstructions (narrowing) of the upper airways
• Pulmonary diseases of the pulmonary circulation such as pulmonary hypertension (high lung pressure)
• Pulmonary allergies
• Abnormal breath sounds in infants
• Chronic cough

Around 10% of all children and adolescents in Germany suffer from bronchial asthma @ megaflopp /AdobeStock

Diagnostic methods in pediatric pneumology

The pediatric pulmonologist first asks about

• The child's symptoms
• Lifestyle habits
• Medication taken and
• any illnesses or diseases suffered by family members (medical history)

This is followed by a physical examination. An important part of the examination is auscultation. Here, the specialist uses a stethoscope to listen to the sounds made in the lungs and adjacent tissues. This gives him indications of any obstruction of the airways, pulmonary hyperinflation or inflammation.

The pediatric pulmonologist can test lung function using spirometry or body plethysmography. These examinations are also known as pulmonary function tests (Lufu).

They provide information about

• How much air the patient breathes in and out
• How much air remains in the lungs after exhalation and
• How quickly the air flows

It can therefore precisely record the functional state of the airways and lungs. It can therefore detect diseases at an early stage.

During the lung function test, the child breathes into the measuring device (spirometer) via a mouthpiece using only their mouth @ Aliaksandr Siamko /AdobeStock

During spirometry, the patient breathes into a device via a mouthpiece with their nose closed. This registers the various lung function parameters.

Bodyplethysmography is basically similar. However, the patient is placed in an airtight glass cabin during the examination. This method is somewhat more accurate than spirometry.

Ergo-spirometry measures lung function under physical stress. Here, the patient is on a bicycle ergometer or treadmill during the examination. This allows the doctor to detect hidden lung disorders that only occur during physical exertion.

Pulse oximetry, on the other hand, provides information about the oxygen saturation in the blood. In some lung diseases, there is a drop in the oxygen content in the blood.

Another examination procedure is bronchoscopy. Here, the doctor inserts an endoscope into the patient's airways via the mouth or nose under anesthesia.

This allows him to view the bronchi and lungs via a camera. During the bronchoscopy, the doctor can also remove mucus as well as cell and tissue samples (bronchoalveolar lavage, bronchial lavage).

The pediatric pneumology expert also has other diagnostic options at his disposal, such as

• Ultrasound examinations (sonography) of the lungs and pleura as well as other imaging examinations such as X-rays of the lungs and lung scintigrams (perfusion scintigraphy, ventilation scintigraphy)
• Sputum diagnostics (examination of sputum)
• Pilocarpine iontophoresis sweat test (also just called sweat test) to detect cystic fibrosis

Treatment of lung diseases in children

The therapy depends primarily on the disease. If the breathing difficulties are due to an inhaled foreign body, the doctor can remove it directly during bronchoscopy.

In the case of bacterial pneumonia, the doctor will prescribe antibiotics. However, these do not help with inflammation caused by viruses. To prevent a so-called superinfection with bacteria, children are often given antibiotic medication anyway.

Some lung diseases cannot be treated causally. The aim here is not to cure the disease, but to alleviate the symptoms.

Patients with cystic fibrosis, for example, receive mucolytic medication and training on how to cough up mucus using autogenous drainage.

They also offer asthma training so that children and parents learn how to live with the disease.

Long-term oxygen therapy, ventilation therapy and home ventilation are therapeutic options for particularly severe lung diseases.